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The relationship between TSH and systemic inflammation in extremely preterm newborns

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Abstract

Elevated thyrotropin (TSH) levels in critically ill extremely premature infants have been attributed to transient hypothyroidism of prematurity or non-thyroidal illness syndrome. We evaluated the hypothesis that relatively high TSH levels in the first 2 postnatal weeks follow recovery from systemic inflammation, similar to non-thyroidal illness syndrome. The study was conducted in 14 Neonatal Intensive Care Units and approved by each individual Institutional Review Board. We measured the concentrations of TSH and 25 inflammation-related proteins in blood spots obtained on postnatal days 1, 7, and 14. We then evaluated the temporal relationships between hyperthyrotropinemia (HTT), defined as a TSH concentration in the highest quartile for gestational age and postnatal day, and elevated levels of inflammation-related proteins. 880 newborns less than 28 weeks of gestation were included. Elevated concentrations of inflammation-related proteins during the first or second week did not precede day-14 HTT. Systemic inflammation on day 7 was associated with day-14 HTT only if inflammation persisted through the end of the 2 week period. HTT frequently accompanied elevated concentrations of inflammation-related proteins on the same day. The hypothesis that HTT follows recovery from severe illness, defined as preceding systemic inflammation, is weakly supported by our study. Our findings more prominently support the hypothesis that TSH conveys information about concomitant inflammation in the extremely premature newborn.

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Acknowledgments

Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke (5U01NS040069-05; 2R01NS040069-06A2), the National Institute of Child Health and Human Development (5P30HD018655-28), and the National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007699-31S1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding institutions did not contribute to the collection, management, analysis, and interpretation of the data; nor preparation, review, or approval of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest or disclosures relevant to the subject matter or materials included in this work.

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Authors and Affiliations

  1. Department of Medicine, Divisions of Endocrinology and Medicine Critical Care, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Carmen L. Soto-Rivera & Michael S. D. Agus

  2. Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Raina N. Fichorova

  3. Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Elizabeth N. Allred & Alan Leviton

  4. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Linda J. Van Marter

  5. Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Linda J. Van Marter

  6. Division of Newborn Medicine, Baystate Children’s Hospital, Springfield, MA, USA

    Bhavesh Shah

  7. Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Camilia R. Martin

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  1. Carmen L. Soto-Rivera
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  2. Raina N. Fichorova
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  3. Elizabeth N. Allred
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Corresponding author

Correspondence to Carmen L. Soto-Rivera.

Additional information

Linda J. Van Marter, Bhavesh Shah and Camilia R. Martin have contributed equally to this work.

On behalf of ELGAN Study Investigators

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Soto-Rivera, C.L., Fichorova, R.N., Allred, E.N. et al. The relationship between TSH and systemic inflammation in extremely preterm newborns. Endocrine 48, 595–602 (2015). https://doi.org/10.1007/s12020-014-0329-4

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  • DOI: https://doi.org/10.1007/s12020-014-0329-4

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